Hello everyone.
I'm 32 I've been on bcp for almost 10 years now. 1 year on Diane and the other 9 on Yasmin. I've always had acne even on bcp, although not as severe as pre-bcp, but for the last 2 years and especially now in 2021, something happened that made my skin to not breakout anymore. I have maybe 1 spot per month.Not sure if it's because I completely quit using any type of foundations andbb creams or because I'm taking anti-oxidant supplements (Turmeric and Resveratrol). Also, I changed to taking a pill daily, without a 7 days break which might have affected it.
I don't really have that many side effects from the pill, or at least nothing super obvious - my digestion is extra bad lately (which is weird, because skin is clear anyway)but it was never good, so not sure how much the pill has contributed. My sex drive is non-existant, but it's not a problem because I don't date. Some anxiety, but not worse than in my 20's. Dunno...
However, the increased health risks are always on my mind. Sometimes I remember the fact that I might be exposing myselt to increased cancer risk or blood clots and I instantly start having loads of anxiety. I read that the risk in not really that hight in total, but I can't stop worrying.
Do you think its worth weaning off the pill or should I stay on it since I don't have side-effects and my skin is good?
I once took Belara bcp in my teenage years and went off of it at 19 years old. It was a catastrophy, not only did I get cystic acne, but also some acne conglobata on one of my cheeks (interconnected cysts), which left me awfully scarred.
My common sense tells me the less we do to our bodies the better, so I hear you about wanting to wean off of it. But I also hear you that your skin is good, so "if it ain't broke don't fix it" thoughts are there.
However, you're 32, so maybe you are just naturally growing out of acne. In that case, you could safely wean off. But it's an unknown. Whatever you do, let us know. And keep in mind that you might break out as you wean off, so you need to give it a little time to get back to normal.
I don't think you should worry about blood clots if you are bcp for that long. I read that the risk for clots are highest when you are just starting bcp or go off for at least 4 weeks and restart again. If you're still worried you can ask your doctor for a PT or PTT blood test to check how fast your blood clots. I'm 44 years old and I'm taking bcp with no breaks for the 25 years (started at 19). I had severe cystic acne and all the acne treatments the dermatologists gave me didn't work on me. Nothing can clear up my skin the way bcp does, except maybe for spiro but I haven't tried that. It makes me feel good to know it reduces the risk of ovarian cancer while I breeze through perimenopause. I go for mammograms and sonograms every 6 months for intraductal papilloma which is common in women in their 40s. My breast surgeon knows I'm on bcp and she's not concerned. Neither is my general doctor. He's actually sounds elated whenever I ask for refills. The gyne clinic shook their heads and said I'm not supposed to be on bcp for that long. Then they shrugged their shoulders and say "why not?" when they saw I had no ill effects.
About your question whether skipping placebo pills and going straight to the next pack helps clear up even more acne, I actually experienced more anti-androgenic effects while doing that on Yaz. My skin was already clear even when I took the 4 day breaks, but when I used it continuously, oh wow, I can't even detect any oil my skin and scalp. My eyes were so dry, my contacts feltlike rocks on my eyeballs. My hair felt like straw. I want my sebum back! Never thought I'd hear myself say this.
You may not have acne. It might be Rosacea Subtype 2 with papules and pustules. Rosacea Subtype 2 is frequently misdiagnosed as bacterial acne especially if your face isn't particularly red from the rosacea. When the usual bacterial acne treatment doesn't work it may get written off as "hormonal acne". This happened to me for decades. 4 board certified dermatologists misdiagnosed the condition as bacterial acne. The 4th one said "gee you have had this a really long time, maybe its hormonal". None of them ever ran any tests, just performed the "10 second glance exam".
A large number of people with Rosacea Subtype 2 also have Small Intestinal Bacterial Overgrowth (SIBO) or Small Intestinal Fungal Overgrowth. Most of the human immune system is in the gut. SIBO/SIFO affects the immune system allowing microscopic demodex skin mites to become severely overpopulated on the skin resulting in Rosacea Subtype 2(skin) and Subtype 3(eyes). Everyone has a few of these mites - a healthy immune system keeps the population under control. The mites eat skin oil and possibly skin cells. The mites live on a 2 to 3 week cycle. When they die they form pustules of dead mites. The cyclical behavior can sometimes lead to a hormonal acne misdiagnosis. Skin symptoms may include: large blackheads, pustules, papules, body acne, scalp acne, red eyes, ocular rosacea/blepharitis demodex.
SIBO can treated in 1-3 weeks with the right antibiotic. SIFO requires treatment with an antifungal drug. The types of antibiotics used to treat bacterial acne are not the ones they give to treat SIBO. Any given antibiotic only works on a small number of types of bacteria. To clear the infection the correct antibiotic and/or antifungal drughas to be used. To diagnose the bacteria and or fungus causing the SIBO/SIFO they do an endoscope test to collect a small sample of fluid from the intestine. The fluid is tested for bacteria and fungus. The doctor can then select the correct antibiotic and/or anti-fungal oral drug to clear the overgrowth.
Here are 2 medical studies that tested 2 different antibiotic treatments shown to clear demodex skin mites. The first study tested Oral Ivermectin alone versus using a 2 drug treatment Oral Ivermectin + Oral Metronidazole. Adding Oral Metronidazole to the treatment was far more effective than Oral Ivermectin alone. At the time of the study, the medical researchers were not certain why Oral Metronidazole helped so much. Oral Metronidazole is highly effective against 2 different bacteria known to cause SIBO. The combined treatment worked for me after having Rosacea Subtype 2 misdiagnosed as bacterial acne along with SIBO for decades. Oral Ivermectin and Oral Metronidazole are available as inexpensive generic drugs.
https://www.sciencedirect.com/science/article/pii/S120197121201315X
The following medical study from 2016, tested the expensive antibiotic Rifaximin on Rosacea patients confirmed to have SIBO. It worked in a large number of cases. Rifaximin is highly effective against E. Coli bacteria which is known to cause SIBO. Rifaximin does not work against all types of bacteria known to cause SIBO. That why the endoscope test results are important to select the right antibiotic for treatment.
https://www.jaad.org/article/S0190-9622(12)02330-4/fulltext
Treatment with Accutane or BCP may temporarily make the skin look better as it starves the mite population down by drastically reducing the skin oil. But the mite population can rebound after the Accutane/BCP is discontinued. In the long run if SIBO is the problem, Accutane is not the answer, it only treats the symptoms not the gut issues that are causing the real problem. Accutane also has a lot of dangerous side effects making it a drug to avoid if at all possible.
Eating a healthy well balanced diet low in sugar along with probiotics and drinking plenty of water can help keep the gut healthy.